Provider Demographics
NPI:1851867394
Name:FIGHT BACK PERFORMANCE AND RECOVERY, LLC
Entity Type:Organization
Organization Name:FIGHT BACK PERFORMANCE AND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:980-209-0656
Mailing Address - Street 1:1200 E MOREHEAD ST STE 190
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2946
Mailing Address - Country:US
Mailing Address - Phone:980-209-0656
Mailing Address - Fax:
Practice Address - Street 1:1200 E MOREHEAD ST STE 190
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2946
Practice Address - Country:US
Practice Address - Phone:919-619-8231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy